<%@ page language="java" contentType="text/html; charset=ISO-8859-1"
    pageEncoding="ISO-8859-1"%>
<!DOCTYPE html PUBLIC "-//W3C//DTD HTML 4.01 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">
<html>
<head>
  <meta http-equiv="Content-Type" content="text/html; charset=ISO-8859-1">
  <title>UCSUR - Taller de Programacion</title>
  <!-- JQuery -->
  <script type="text/javascript" src="js/jquery-1.11.1.min.js"></script>
  <!-- Importando el Bootstrap en la pagina JSP -->
  <link rel="stylesheet" type="text/css" href="css/bootstrap.css" />
  <link rel="stylesheet" type="text/css" href="css/bootstrap-theme.css" />
  <script type="text/javascript" src="js/bootstrap.js"></script>
</head>
<body>
 <div class="container">
    <jsp:include page="jsp_componentes/cabecera.jsp"></jsp:include>
    <div class="row clearfix">
      <div class="col-md-3 column">
        <jsp:include page="jsp_componentes/menu.jsp"></jsp:include>
      </div>
      <div class="col-md-9 column">
  <form class="form-horizontal">
<fieldset>

<!-- Form Name -->
<legend>Modificar Perfil de Usuario</legend>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="textinput">Nombre</label>  
  <div class="col-md-4">
  <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="textinput">Apellido</label>  
  <div class="col-md-4">
  <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md">
    
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="textinput">Direccion</label>  
  <div class="col-md-4">
  <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md">
    
  </div>
</div>

<!-- Select Basic -->
<div class="form-group">
  <label class="col-md-4 control-label" for="selectbasic">Departamento</label>
  <div class="col-md-4">
    <select id="selectbasic" name="selectbasic" class="form-control">
      <option value="LIMA">LIMA</option>
      <option value="TRUJILLO">TRUJILLO</option>
      <option value="AREQUIPA">AREQUIPA</option>
      <option value="CUZCO">CUZCO</option>
    </select>
  </div>
</div>

<!-- Text input-->
<div class="form-group">
  <label class="col-md-4 control-label" for="textinput">Tarjeta de Credito</label>  
  <div class="col-md-4">
  <input id="textinput" name="textinput" type="text" placeholder="" class="form-control input-md">
    
  </div>
</div>

<!-- Select Basic -->
<div class="form-group">
  <label class="col-md-4 control-label" for="selectbasic">Tipo de Tarjeta</label>
  <div class="col-md-5">
    <select id="selectbasic" name="selectbasic" class="form-control">
      <option value="AMERICAN EXPRESS">AMERICAN EXPRESS</option>
      <option value="VISA">VISA</option>
      <option value="MASTERCARD">MASTERCARD</option>
    </select>
  </div>
</div>

<!-- Textarea -->
<div class="form-group">
  <label class="col-md-4 control-label" for="textarea">Preferencias</label>
  <div class="col-md-4">                     
    <textarea class="form-control" id="textarea" name="textarea"></textarea>
  </div>
</div>

<!-- Button (Double) -->
<div class="form-group">
  <label class="col-md-4 control-label" for="button1id"></label>
  <div class="col-md-8">
    <button id="button1id" name="button1id" class="btn btn-primary">ACEPTAR</button>
    <button id="button2id" name="button2id" class="btn btn-primary">CANCELAR</button>
  </div>
</div>

</fieldset>
</form>
  

      
</body>
</html>